Table 4.

Application of the 5C model to Nepali, Zambian, and Senegalese context with the associated interventions utilized to raise demand.

Construct*	Correlation	Nepali context	Zambian context	Senegalese context
Confidence Trust in vaccines, the health system, and the motivations of policy makers.	Positive	Trust in government and media information on vaccines, as well as vaccines themselves; perceived reductions in outbreaks, disease, disability; some refusal among religious groups, caste, ethnicity, etc.	General community trust in vaccines; some distrust and misinformation seen that communities address directly	Parents trust vaccines; some rumors surrounding vaccines and infertility, side effects, and adverse events, which are addressed via government guidelines
		Interventions: FCHWs for community level health information; education via FCHVs/CHWs, schools, media; Media partnership with MoH	Interventions: CHWs for community level health information; Education via CHWs, schools, media; Media partnership with MoH; 'Indabas' meetings with local leaders	Interventions: CHWs for community level health information; Education via CHWs, schools, media; Media partnership with MoH; Guidelines to address rumors at different levels
Collective Responsibility A willingness to protect others.	Positive	Strong community ties and empathy as a cultural value; health as a human right. Codified into law	Widespread community involvement. Community is encouraged to report any challenges for government to respond/fix	Health as a human right; strong community ownership of health outcomes and vaccine programming
		Interventions: FCHVs/CHWs for community level health information; codification of health as a human right; Education via FCHVs/CHWs, schools, media	Interventions: CHWs for community level health information and education; 'Indabas' meetings with local/traditional leaders	Interventions: CHW's for community level health information and education; Education via FCHVs/CHWs, schools, media; Community leaders, committees, and CBO engagement
Complacency Risk of disease is seen as low; vaccines are believed to be unnecessary.	Negative	Parents perceive a high risk from vaccine-preventable disease. Active pursuit of vaccination among most communities	Vaccines are seen as important and necessary in reducing morbidity and mortality; Outbreaks occurred recently, showing the risk of disease	Parents understand the risk of infectious disease and the importance of vaccines; some outbreaks occurred in recent memory in border communities
		Interventions: Education via FCHVs/CHWs, schools, media; set days and locations for vaccination	Interventions: Education via CHWs, schools, media; local laws	Interventions: Education via CHWs, schools, media
Constraints Structural and psychological barriers create difficulties with accessing vaccines.	Negative	Easy access to vaccines; religious and cultural leaders promote vaccination. Constraints may vary by geography, particularly those in hard-to-reach mountainous areas or during the rainy season	Barriers include long distances to health facilities and competing priorities; constraints may vary by geography and region but do not always affect uptake as parents will sometimes persist through barriers to ensure child is vaccinated	Constraints differ by province and geography – includes long distances to health facilities, poor transportation, and poor infrastructure. Does not always negatively affect uptake; parents sometimes persist through barriers to ensure childhood vaccination
		Interventions: Set days and locations for vaccine days; supply chain improvements; health post expansion	Interventions: Supply chain improvements; health post expansion; context-specific adaptablity to community availablity in rural areas	Interventions: Context-specific adaptability to community availablity in rural areas; supply chain improvements; health post expansion
Calculation Uncertainty, information searching, and cost-benefit calculations.	Negative	High trust in government and vaccine information; FCHVs are highly regarded community members	Believe and trust in information provided by government and community-based organizations	Trust in media and government; may differ by province and social media use
		Interventions: FCHVs for community level health information; Media partnership with MoH; Education via FCHVs/CHWs, schools, media; online news portal	Interventions: CHWs for community level health information; Media partnership with MoH; Education via CHWs, schools, media	Interventions: CHWs for community health information; Association of Journalists Media Partnership; press caravans

^*Definitions adapted from Betsch et. al. 5C psychological antecedents of vaccination constructs.